The French journal of urology · 2025
Laser applications in Endourology: Conservative treatment of upper tract urothelial carcinoma and ureteral strictures.
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Panthier Frédéric, Doizi Steeve, Almeras Christophe, Abid Nadia, Traxer Olivier
Аннотация
BACKGROUND: Laser applications for the treatment of upper urinary tract diseases are gaining popularity. This review aimed to summarize the current evidence on the laser energy utilization in the conservative management of upper tract urothelial carcinoma (UTUC) and ureteral strictures.
METHODS: A narrative review of the literature was conducted up to April 2025 without time restriction, using the PubMed/Medline, Scopus, and Cochrane databases. The keywords "laser", "transitional cell carcinoma", "upper tract urothelial carcinoma", "ureteral stricture", "ureteral stenosis", and "conservative treatment" identified eligible publications. Literature reviews, meta-analyses, original articles, case reports, and updates were eligible, allowing retrieval of certain publications not identified otherwise. Books, editorials, commentaries, and letters to the editor were excluded. Due to data heterogeneity, a narrative review was decided.
RESULTS: Pulsed (Holmium:YAG [Ho:YAG], Thulium Fiber Laser [TFL] and pulsed Thulium:YAG [p-Tm:YAG]), and continuous lasers (Neodymium:YAG [Nd:YAG], TFL, and Tm:YAG) are eligible for the conservative treatment of low-risk UTUC. Laser fiber diameters ranging from 150 to 365μm are preferable, as well as digital ureteroscopes. Ablation and hemostasis are performed with Peak Powers ranging from 500 to 1500W, and using 0.8-1J /10-15Hz laser settings. A "second-look" ureteroscopy is recommended due to the early recurrence risk and incomplete treatments. Long-term recurrence rates range from 17 to 75%, without differences between laser sources. Laser endoureterotomy is an expert procedure, most often associated with ureteral dilation and stenting. No laser source has shown superiority for this indication.
CONCLUSION: Lasers utilization in the conservative treatment of low-risk UTUC is growing although strict patient selection and close follow-up are mandatory.
METHODS: A narrative review of the literature was conducted up to April 2025 without time restriction, using the PubMed/Medline, Scopus, and Cochrane databases. The keywords "laser", "transitional cell carcinoma", "upper tract urothelial carcinoma", "ureteral stricture", "ureteral stenosis", and "conservative treatment" identified eligible publications. Literature reviews, meta-analyses, original articles, case reports, and updates were eligible, allowing retrieval of certain publications not identified otherwise. Books, editorials, commentaries, and letters to the editor were excluded. Due to data heterogeneity, a narrative review was decided.
RESULTS: Pulsed (Holmium:YAG [Ho:YAG], Thulium Fiber Laser [TFL] and pulsed Thulium:YAG [p-Tm:YAG]), and continuous lasers (Neodymium:YAG [Nd:YAG], TFL, and Tm:YAG) are eligible for the conservative treatment of low-risk UTUC. Laser fiber diameters ranging from 150 to 365μm are preferable, as well as digital ureteroscopes. Ablation and hemostasis are performed with Peak Powers ranging from 500 to 1500W, and using 0.8-1J /10-15Hz laser settings. A "second-look" ureteroscopy is recommended due to the early recurrence risk and incomplete treatments. Long-term recurrence rates range from 17 to 75%, without differences between laser sources. Laser endoureterotomy is an expert procedure, most often associated with ureteral dilation and stenting. No laser source has shown superiority for this indication.
CONCLUSION: Lasers utilization in the conservative treatment of low-risk UTUC is growing although strict patient selection and close follow-up are mandatory.